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Ortho PANRE 2

Orthopedics

QuestionAnswer
Acromion process Type I: Flat, smooth acromion at clavicular joint; normal subacromial space
Acromion process Type II: Hooked acromion; subacromial space mildly decreased
Acromion process Type III: Hooked acromion with spur; subacromial space significantly decreased
Night pain: may indicate Rotator cuff injury, Impingement, Frozen
Scapular winging/trauma = Serratus or Trapezius dysfxn
Unable to externally rotate = Posterior dislocation
Supra/infraspinatus wasting = RCT or suprascapular n. palsy
Pain or “clunk” w/ motion = Labral tear
Rotator cuff: tests for impingement Neer; Hawkins (both passive)
Test of AC joint crossover (passive)
Tests for biceps tendonitis Speeds; Yergason (both active)
Tests for anterior shoulder instability Sulcus; apprehension & relocation (both passive)
Tests for labral tears Obrien; anterior slide; crank
Circulation tests Adson; Allen; Roos
Shoulder imaging: Standard views: AP and axillary
Imaging: Can get Y view if: suspected dislocation or scapular fx (trauma)
Best imaging for RCT CT arthrogram good, but MRI is better (invasive)
Posterior SC Dislocations: Concern Can be life-threatening; immediate referral and CT
Posterior SC Dislocations: Mgmt Closed reduction or surgical reduction
95% of shoulder dislocations are: Anterior Dislocations
Biceps Rupture: usually involves: long head of biceps (short head rupture rare)
Avulsion of the antero-inferior glenoid labrum = Bankart lesion
Compression fx of posterior humeral head = Hill-Sachs lesion
Shoulder dislocation: xray & reduction maneuvers (3): Rowe (opposite ear over head), Stimson (prone), Hippocratic (traction)
Most common cause of shoulder pain Impingement
Single most sensitive and specific physical exam finding in rotator cuff tears weakness with resisted external rotation and or abduction
Posterior fat pad on elbow x-ray = Always pathologic
Posterior fat pad sign in adults may indicate: radial head fx
Posterior fat pad sign in kids = supracondylar fx
Radial Head Subluxation AKA Nursemaids Elbow
Radial Head Subluxation = Annular ligament entrapment
Distal Humerus Fx: use ____ Classification Mehne & Matta
Most common elbow fracture in children Supracondylar Fx
Radial Head Fx: Mgmt: Type I (non-displaced) Posterior splint/sling for 3-5 days; Early ROM exercises
Radial Head Fx: Mgmt: Type II (displaced) Tx as in Type I if < 30% head displaced (Otherwise: ORIF)
Radial Head Fx: Mgmt: Type III (comminuted) Excision of frags or complete radial head
Radial Head Fx: Mgmt: Type IV (dislocated) Same as III
Olecranon Fx: Check: N/V function; Ulna n.
Gilula Arcs: articular surfaces of carpal bones s/b: parallel, joint spaces similar width & parallel cortical margins
Gilula Arcs: any break in the lines or overlapping of normally parallel joint spaces suggestive of: joint injury
Tinel Sign Percuss over median n. carpal tunnel; tingling or pain in median n. distn = Pos
Phalen Test Acute flexion of wrists for 60-90 sec => numbness & tingling over median n. distn
Scapholunate Dissociation: S/S Wrist pain & instability; Letterman sign; Watson Test
Ulna Impaction Syndrome: leads to: lunotriquetral ligament attrition
Kienbock Dz = Lunatomalacia
Monteggia fx = Ulna shaft fx; Proximal radius dislocation
Monteggia fx: tx ORIF vs long arm cast for 6 weeks
Galeazzi fx = Radial fracture; distal Ulna dislocation
Galeazzi fx: tx ORIF vs long arm cast 6 weeks
Both Bone Forearm Fx: Non displaced, non-angulated fx: may be put in long arm cast 6 wks
Smith Fx: MOA Fall on back of hand; Hyperflexion injury; volar angulation of distal fragment
Smith Fx: minor angulation = acceptable; short arm cast 4-6 wk
Smith Fx: significant angulation = Reduction, CRPP, ORIF
Barton Fx = Intra-articular fracture; displaced radial articular fragment
Barton Fx: tx ORIF
Chauffeur Fx: MOA Oblique fx through the base of the radial styloid
Chauffeur Fx: Tx Long arm cast for 1 mo. followed by short arm cast for 2 wks
Torus Fracture = Buckle fracture with intact periosteum
Scaphoid Fx: 1/3 will develop: osteonecrosis
90% of distal radial fractures are: Colles Fx; FOOSH injury; dorsal angulation of distal fragment
Most common carpal fx = Scaphoid Fx (2/2 FOOSH)
CMC Osteoarthritis: Compression test moving CMC Joint w/ longitudinal load applied
CMC Osteoarthritis: Grind test grab the metacarpal base & rotate thumb
Dupuytren Contracture: Rx No conservative Rx; Surgery indicated for fixed contracture of more than 30 degree
Trigger Finger = Stenosing Tenosynovitis
Trigger Finger: Injection: At site of tenderness/ nodule; Marcaine/ Kenalog; 25 g needle into sheath, not tendon
Hand Lacerations: No Mans Land = btw distal palmar crease & PIP joint crease
Septic Tenosynovitis = Bacterial infection of a tendon & tendon sheath
Septic Tenosynovitis: Hx puncture, bite, or tooth wound (fight bite); progressive swelling & pain over 24-48 hr; Kanavel Sx:
Kanavel Sx: Fusiform swelling of finger; sig tenderness along course of tendon; marked pain on passive extension; flexed finger at rest
Septic Tenosynovitis: Etiology: Staph, Strep, MRSA
Septic Tenosynovitis: Rx: IV Abx, I&D if progressing; consider tetanus & rabies prophylaxis
Most common digital infection = Infection: Paronychia
Infection: Paronychia = Localized staph cellulitis in gutter along fingernail
Infection: Paronychia Rx: Soaks, PO antibiotics; digital block & I&D when abscess is organized
Infection: Felon = Abscess of pulp space of distal phalanx
Subungual Hematoma: Tx Evacuate hematoma; trepanation (burr hole into nail); X-ray
Subungual Hematoma: If > 50% of nail is affected: nail s/b removed & laceration sutured
Osteoarthritis: Heberdens nodes: DIP joint
Osteoarthritis: Bouchards nodes: PIP joint
Boutonniere Deformity = Loss of central slip insertion on proximal dorsal middle phalanx
Boutonniere Deformity S/S Flexion of PIP & hyperextension of DIP
Swan Neck Deformity = Joint Synovitis secondary to RA
Swan Neck Deformity on physical exam: Flexion of the DIP & hyperextension of the PIP
Skiers Thumb AKA: Gamekeepers thumb
Skiers Thumb: Stener lesion = Aponeurosis interposed between ligament
Bennet Fx = Fx of thumb metacarpal base
Bennet Fx: Tx: Comminuted = Rolando fx
Metacarpal Fx: 5th MC neck fx = Boxers fx
Metacarpal Fx: MC Neck: Tx: with > 40 degree angulation or extension lag: CRPP
Hook of Hamate Fx = Direct impact from racquet, baseball bat
Mallet Finger = Rupture of extensor tendon distal to DIP
Mallet Finger: PE: Unable to actively extend DIP
Jersey Finger = Forceful extension of DIP; FDP avulsion
Jersey Finger: S/S Pt unable to flex DIP; most common to ring finger
Created by: Abarnard